Long-term follow-up of treated and untreated hyperprolactinaemic patients

Summary

The clinical and endocrine course of 43 hyperprolactinaemic women, followed for a median period of 48 months, was analysed. A tentative distinction between hyperprolactinaemia with and without pituitary tumour was made by a plain lateral and frontal radiograph of the skull, supplemented by tomography of the sella when indicated. Seventeen women had radiological evidence of a pituitary adenoma. Serum prolactin levels in this group were significantly higher than those from women with normal radiological findings, but the presenting clinical symptoms were comparable in both groups. Twelve of our 43 patients received no treatment, 25 patients were treated with bromocriptine for 1 to 48 months and 6 patients were treated with a combination of bromocriptine, radiotherapy and surgery. Twenty six conceptions and 20 full-term pregnancies were achieved. Complications due to pituitary tumour growth during pregnancy occurred in one patient. Cure of hyperprolactinaemia was observed in 3 patients treated with bromocriptine alone, and in 2 patients who had radiotherapy and surgery. Neither spontaneous regression nor deterioration of hyperprolactinaemia occurred in untreated patients. Neither the radiological diagnosis nor the clinical or hormonal profile at the initial visit were predictive of the course of the disease and the outcome of treatment. Providing strict criteria for the diagnosis of hyperprolactinaemia are applied, attempts to differentiate between pituitary microadenoma and functional hyperprolactinaemia are clinically irrelevant.